The Significance of the Hospital’s Tiniest Organism

We are approaching November which means we are nearing the first half of clerkship. A lot of my co-clerks have been posting a lot of their ‘firsts’. First IV insertion, first NGT insertion, first extraction, first OR, or sometimes sadly, first birthday away from our families. It is an interesting thing– to have the wonders and simple joys of a child over our accomplishments. Some of us feel like stage moms of ourselves who are proud of every baby step we make. And yet after grueling hours of our duty days, we still see patients die despite all our efforts, we still get insulted by superiors, patients and their relatives, nurses, hospital staff– practically everyone, we still get hours of demerits for being human, we still get soaked in all shit possible (literally and figuratively). Clerkship is indeed a funny thing. You do tons of jobs everyday but somehow, you do not feel as purposeful as you thought you would be.

Clinical clerks have a very ambiguous role in the hospital. This is also why we get to have jobs that overlap those of doctors’, nurses’, medtechs’, even maintenance staff’s works. Patients and their relatives usually have no idea what our roles are and would call us random titles, ‘Doc’, ‘Nurse’, ‘Miss/Sir’, ‘Ate/Kuya’, or simply, ‘Hoy’. I personally respond to any name though. I remember this one exhausting Pedia duty and the patient’s Dad personally called me from our space. I thought it was urgent since he took so much effort in looking for me so I felt alarmed and rushed to their room only to be asked whether I knew how to fix the electric fan because the air from it was not reaching his son. I wanted to cry and laugh during that time. It was not because I was annoyed with the Dad. I understood that he really wanted the best for his kid (especially since the baby was his first child). It was not because I was thought to be a maintenance personnel, or because I felt degraded, or because my tiny rest was disturbed, or because I really had no idea how to fix the problem. It was because I felt like an odd teenager who did not seem to fit in. Being a clerk feels like being a double for many, many characters in a movie. But when the credits roll, you are not named as any character, but simply a double. No one really remembered what you did or that you were in the movie at all.

I may sound like I am whining but believe me, I am not. I think that this is the primary rule of clerkship: Do not complain. It sucks to go around the whole hospital doing monitoring for countless times to the point that you hear Korotkoff sounds even while you are sleeping. It sucks that despite reading piles of books and notes for the last three years, your most used phrases are ‘Yes, noted, Doc.’ and ‘Sorry, Doc.’ when you are speaking with residents and consultants. It sucks to be so excited over badass surgical techniques that you have seen in Grey’s Anatomy in the OR only to be told to not scrub in and keep on talking so as not to let the surgeon fall asleep. It sucks to be reminded over and over again how you know nothing. It sucks to be told that well, you simply suck at whatever you are doing. But despite everything, I do not think complaining will make me a better doctor. The work gets tiring, yes. But I always remind myself that what sucks the most is not any of these. What sucks the most is the feeling of being sick and helpless. This alone makes me able to forget my childish thoughts and I am reminded that I am there to help alleviate that worst feeling in the world.

A lot of times, i just sit in one corner and wonder if we are of any loss to the hospital. Honestly, as I have mentioned, everything in our job description is not unique. All of our works can be done by other hospital staff. If we do not exist, someone else can do the histories, physical examinations, monitoring, insertions, extractions, etc. There is not a thing that only a clinical clerk can do. Without us, the staff will have more work to do but it does not necessarily mean that the hospital will collapse. There are many hospitals without clerks anyway. But these five months made me realize what makes a clerk’s role special is not the work itself but the enthusiasm and sincerity in doing it. I am not saying that other hospital staff are doing their jobs half-heartedly, but after working for so long, these things do not excite them any longer. Clerks who do not have much experiences are often more eager to do these things. The feeling of being entrusted tasks makes us more careful with our work. Our works have sincerity. And to me, that is something that we should all be proud of. It is disheartening how a lot of patients would reject our services because of our age and lack of experience. But I really do hope that people would grow to trust us more because our lack of experience is our driving force to make sure that we are always ready to give our best.

I am convinced that I have learned a lot over the last five months and I am still very much excited to learn a whole lot more. I believe that what I know now is not even worth one page of my imaginary book of learning in Medicine. We are writing nothing more than one full sentence of that book. It feels like a long way to go but then all great books are written that way: the first part is always the hardest. It is not because the climax is there or because it is the most complicated part of the story. It is because it creates the ‘make-or-break’ phase. Clerkship to me is like that. It seems like the hardest part to write in our story because we want our readers to feel that hey, we are worth reading. To some, this may just be a part of the rules to become a doctor. But to me, this is the glimpse of what kind of physician we would be. And this is why no matter how microscopic we are compared to the universe of Medicine, we should all want to be the best goddamn organism there is.

Remodelled Realizations: Ideals that Medicine Has Proven Me Wrong

I have lost count on how many times I flipped my books, reviewers, and reports this academic year out of frustration. This whole year, I really have felt like I have become more like an adult with my ideals in life slowly shattering before me. I have expected the difficulty because it is already a given but I was taken aback by the feeling of merely wanting to survive. As far as I am concerned, it was not a part of my plan to just survive. It was my goal to enjoy the ride because this is what I am about to do all my life anyway. But reality was slithering around the apple of my optimism. I was starting to feel tired although I barely admitted this to anyone. Many days I really felt a kind of hollowness growing inside. Then I remembered writing this prayer last year and slipped it in my copy of Guyton:

I stopped and realized the huge difference between my first and second year selves. No, I do not think I’m such a wreck right now but I am pretty sure I am not as idealistic. Somewhere along the road, I left a part of me with that enormous positivity or maybe I was dropping bits and pieces of it along the way that I barely noticed. I am not sure if it is entirely a bad thing though. Medicine deals about so much harsh truths about pain, suffering, loss, and death. My idealistic and probably borderline naive self would probably not handle all of these things if I keep on believing (or pretending to not see the truth) and I would surely be crushed into bits. Medicine is a science, a guardian of truth and just like any other science, it can prove so many old beliefs false– pathologic etiologies, medical folklore,  pharmacologic mechanisms of actions and yes, even some of my old ideals.

 

MEETING PATIENTS IS A THRILLING EXPERIENCE

I have always that strange dream about me walking through a hospital ward in my white coat. And as I walk further, patients will start to smile and feel relief as I speak with them. I had that strange vision for a long time until we have finally met real patients for our history-taking. I remember getting excited over my first meeting with a patient that I even told my parents about it over dinner like it was a big thing. That day came and it was anything but a thrilling moment. It was very, very humbling. The patient assigned to us has been in the hospital for around two weeks and he has been repeating his story to hundreds of students. He told us that he had a a difficult time sleeping and was looking groggy when we came but he had to answer our questions as a part of his ‘contract’ for discounted hospital bills. He fell asleep as soon as we left and that was when I felt how much of a burden we were to him but he was unable to do anything about it.

I have no idea how many patients have had the same experience. But their participation is irreplaceable in medical students’ learning because how else would a doctor be a doctor without learning from a patient? Not to objectify these patients but learning without them is also like asking a computer scientist to learn without any computer. When I went home after that encounter, I shed some tears and I still do not know how to explain what I felt back then. It was almost like being told Santa wasn’t real after believing his existence all my life. Because I aim to be a doctor, I have always wanted to ease the pain of patients and right at that moment I caused even more pain to the patient. But I told myself that day that I will keep on honoring these patients and their silent contributions by remembering them and praying for them. Instead of thinking about how much pain I have caused them, I want to think about how much I could learn from them to ease the pain of other patients someday.

 

SAVOR THE LEARNING EXPERIENCE IN MEDICINE

All my life I have been told that if I wanted to learn something, I should do it with joy in my heart. I should never be bothered by time because passion for something requires a lifetime that cannot be measured by how fast you have learned it but how deeply you have understood it. I carried this thought with me in medicine. Because I wanted to believe that I am passionate about this career, I read a lot of things. Because I wanted to satisfy my curiosity, I kept asking. Because I wanted to assure myself that I fully understood, I read notes from first year and even from my undergraduate days. Because I wanted to be able to share more, I research the things I do not understand. Clearly, I feel fire inside me each time I get excited over a topic discussed in class or just anything interesting that I have read. But do any of these things matter enough to come out in the exams? No.

I do not believe in my exceptional ability to understand so many things, I am not a superhuman being. College made this thing very clear to me. I am not bothered that I do not get the best grades but it matters to me that I have a grasp on what I am studying. I do not mind not being able to know the books and reviewers word for word because I grew up being told that memorization is the most superficial type of learning that if I want to actually remember it in the long run, I should never memorize but instead, understand. But the truth is that medicine can never work without memorization. It is quite frustrating when you study how something works but you are asked about the smallest details. Sometimes I feel like some exams are more of a test of luck instead of ability because it does not usually matter how much you know if you are going to be asked about the most trivial things. But is there such thing as ‘trivial’ in medicine? Are we even allowed to judge any information as important and unimportant? When it comes to a real patient, it is impossible to know every single detail about him in just one encounter. But say, you have forgotten to note that he a really, really rare case of allergy to some kind of drug and that killed him– can we actually say that this allergy was trivial just because we do not think it was a ‘necessary information’? I hate memorization but I understand how important it is to all of us. The thing about medicine is that every detail can matter. I guess the next time I start complaining about how this is not going to be asked in the board exams or this information will not make the patient feel better, I should remind myself that these ‘memory exams’ are just drills to remind me never to neglect the small details because they can totally save or kill a patient.

THE MEDICAL PROFESSION IS PURE AND NOBLE

My respect for the profession is enormous. I always see it as a noble profession maybe because all the doctors who treated me in the past have shown me that kind of love and concern. In my entrance interview, I was interviewed with three other applicants and they all said the same thing on why the wanted to become a doctor, they wanted to be of help to this society and its people. Whether it was all lip service or whatever, I believed them. In two years, I started to realize that not everybody thinks the same. Some of them do it for their families, for their parents, for the money they would receive after graduation, for the respect and fame, for the two letters after their name. I cringe a little when I hear people getting excited over wearing that white coat to show people (their parents, old friends, ex-boyfriends or girlfriends) how much they are worth. The egocentric nature of some of my peers can sometimes make me feel sorry for the patients who will receive less love because their physicians have too much love for themselves. I remember a ‘joke’ from a doctor that goes like ‘we can forget all the initial treatments but we should never forget our professional fees.’ Whether it is simply an attempt to keep the class awake or not, it still offended my image of medicine.

I am sure I am about to witness more dirt in this career as I walk further and to be honest, I am scared. There are so many scary things about medicine and most of them root from the fact that medicine itself is a battlefield. Competition is not a choice but a life source to a lot of us. Compete with yourself and do not mind what the other players are doing in this game, they tell us. But in a pool of highly ambitious men and women, the temptation to mind other’s business is difficult to resist. Because students know that not everyone can see the light at the end of the line, they want to make sure that they are among those who will. The environment is often suffocating and saddening. The workload itself is too much to handle but the competition is exhausting every ounce of energy you’ve got left.

 

Medicine is tarnished by a lot of dirt like any other profession. But it always boils down to “why are we still doing this?” It is all because we still have that tiny, tiny but powerful thing called hope. Hope that it would get better over time, Hope that it would go our way one day. Hope that this will really be our endgame. You see, medicine did steal away a lot of my precious ideals that led me into this path but at the same time, it offers me more room for new ideals that are probably more realistic. I am still in love the idea of being a doctor and being able to ease other people’s pain while being of service to science and no ‘dirt’ can ever change that.